Citation Nr: 18147921
Decision Date: 11/06/18	Archive Date: 11/06/18

DOCKET NO. 04-05 325
DATE:	November 6, 2018
REMANDED
Entitlement to service connection for an eye disability, to include as secondary to service-connected diabetes mellitus, is remanded.
REASONS FOR REMAND
Entitlement to service connection for an eye disability, to include as secondary to service-connected diabetes mellitus, is remanded.
In September 2017, the Board remanded the Veteran's claim to the Agency of Original Jurisdiction for the scheduling of an additional VA medical examination to determine the etiology of the claimed disability.  In the instructions, the Board specifically requested that a VA examiner provide an opinion as to whether any diagnosed eye disability was at least likely as not either caused or permanently aggravated beyond its natural progression by service-connected diabetes.  In a December 2017 VA medical examination report, a VA examiner diagnosed ptosis of the left eye lid, an epiretinal membrane, and cataracts.  The VA examiner stated that each of those disabilities were unrelated to the Veteran's service-connected diabetes, but did not provide any specific rationale for those opinions.  In a March 2018 addendum, the VA examiner, when asked to provide the rationale for the opinions, wrote that ptosis was an age-related change unassociated with diabetes.  The examiner did not specify whether diabetes could aggravate the Veteran's diagnosed ptosis.  Moreover, when discussing the Veteran's diagnosed epiretinal membrane, the examiner wrote that the disability was most likely a result of a previous bout of anterior uveitis, “but could possibly be exacerbated by his diabetes.”  The examiner did not opine regarding cataracts.  The Board notes that any opinion that indicates that a disability could or might have been aggravated by a service-connected disability is of no probative value in determining the etiology of a Veteran’s claimed disability.  Therefore, a remand is necessary to schedule an additional examination to determine the etiology of the claimed eye disability.  
The matter is REMANDED for the following action:
Schedule the Veteran for a VA eye examination with an appropriate VA clinician who has not examined the Veteran previously to determine the nature and etiology of any eye disabilities diagnosed during the pendency of the appeal, dating to November 2001, to specifically include ptosis of the left eye lid, an epiretinal membrane, and cataracts.  The examiner must review the claims file and should note that review in the report.  In reviewing the evidence, the examiner should note the service medical records, the post-service treatment records, and the Veteran's lay statements.  Any and all relevant studies, tests, and evaluations deemed necessary by the clinician should be performed.  The clinician must then address each of the following and must provide a rationale for each opinion:
(a)  State opine it is at least as likely as not (50 percent probability or more) that each eye disability diagnosed during the pendency of the appeal, dating to November 2001, to specifically include ptosis of the left eye lid, an epiretinal membrane, and cataracts, had its onset in service or is otherwise related to service.
(b)  Please opine whether it is at least as likely as not (50 percent probability or more) that the Veteran's service-connected diabetes mellitus caused each eye disorder diagnosed during the pendency of the appeal, dating to November 2001, to specifically include ptosis of the left eye lid, an epiretinal membrane, and cataracts.
(c)  Please opine whether it is at least as likely as not (50 percent probability or more) that the Veteran's service-connected diabetes mellitus aggravated (permanently increased in severity beyond the natural progress of the disorder) each eye disorder diagnosed during the pendency of the appeal, dating to November 2001, beyond the natural progression of the disease, to specifically include ptosis of the left eye lid, an epiretinal membrane, and cataracts.  Reconcile the opinion with the March 2018 opinion that the epiretinal membrane could possibly be exacerbated by diabetes, and discuss whether cataracts are a disability that is typically caused or aggravated by diabetes.
 
Harvey P. Roberts
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	T.M. Gillett, Counsel